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Pediatric Review

RNSG 2201

What are the priority considerationd in children with mental disorders? Safety and self-esteem
What is considered the usual threshold on an intelligence test for mental retardation? IQ of 70 or less
Aside from intelligence assessments, what else is factored into a diagnosis of mental retardation? Adaptive behaviors, developmental delays, essentially the ability to manage age appropriate tasks of daily living.
What are the main nursing interventions focused on for pts with mental retardation?ing Promoting coping skills, pt and parent education
Characterized by an uneven pattern of intelligence strengths and weaknesses marked by severe developmental delays that cannot be attributed to mental retardation Pervasive Developmental Disorder
Children with ---- may show a lifelong pattern of rigidity, intolerance of change, and behavioral outbursts in response to environmental demands or changes in routine Pervasive Developmental Disorder
Name 2 distinguishing characteristics between autism and other pervasive developmental disorders? Early age of onset (before 30 months) and severe distubance in social relatedness
Autistic disorder Marked impairment of development in social interaction and communication with a restrictive repertoire of activity and interest
Autism gender differences Boys are more likely to have autism but girls tend to be more severely impaired with poorer outcomes if diagnosed
Ascertainment Bias A method of identifying cases for scientific study that creates a sample that differs from the population it is trying to represent. This is thought to be the reason for initial support of indifference of professional parents as a cause for autism.
Biochemical differences in children with autism Increased platelet serotonin levels, excessive dopaminergic activity, and alterations of endogenous opiods
autism medication Haloperidol - demonstrated efficacy in reducing hyperactivity, emotional liability, and stereotypical behaviors
Haloperidol common side effects Autistic children - tardive dyskinesia and withdrawal dyskinesias Recommended: drug holidays every 6-12 months to assess for cont'd need for med
Risperdal / risperidone Found to be a safe and effective txt for reducing aggression, tantrums, and self-injury in children with autism
Ritalin / methylpehnidate for autism Autistic children appear to be more likely to develop adverse effects at med level dosing, including increses in self-injury. Dosing should start low and be incremented very slowly.
Aspergers disorder A severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities.
Aspergers disorder tendencies demonstrate inappropriate initiation of social interactions, inability to respond to usual social cues and a tendency to be concrete in language interpretation.
Autism disorder Seizures
Apergers comorbidity Depression
Pediatric psychological assessment critical elements... Intellectual ability, communication skills and adaptive functioning
Rocking behavior in a child, what should a nurse do? Ignore it, as long as the behavior has no negative effects it should be ignored
Headbanging behavior in a child, what should nurse do? Redirect the child and use positive reinforcement. Env alterations or protective head gear may be needed if other interventions are unsuccessful.
Promoting interaction for children with pervasive development disorders like autism or Aspergers... Foster nonverbal interactions like getting the mail, taking turns during a simple game, passing out snacks. Activities that engage child without speech demands.
Nonverbal learning disorder Mathematical delays
Phonological processing Involves the discrimination and interpretation of speech sounds
Damage to this hemisphere of the brain is thought to be the cause of reading disability Left hemisphere
Dysfunction of this hemisphere of the brain appears to cause mathematics disorders Right hemisphere
Speech refers to the ____ aspects of speaking whereas language refers to ____. Motor / formulating and comprehending verbal communication
A delay in speech may impact... A child's socialization and education
Disruptive Behavior Disorders ADHD, oppositional defiant disorder, and conduct disorders
Externalizing disorder those that are characterized by acting out behaviors like ADHD, ODD, and conduct disorder
Internalizing disorder those that impact mood like depression and anxiety
3 core symptoms of ADHD Impulsivity hyperactivity inattention
ADHD observable brain abnormalities Frontal lobe and functional connections with subcortical structures are dysregulated
Mental health care barriers for children Lack of clarity of the screening process, coordination of services, resources, mental health providers and inadequate reimbursement
Neurochemicals seen with symptoms like depression or suicidality Decreased norepinephrine and serotonin levels
Mania neurochemical Increased levels of norephinephrine
Family Risk factors assoc w/ childhood mental health disorders? Severe marital discord, decreased socioeconomic status, overcrowding, parental criminality, foster care, maternal psychiatric disorder, abuse / neglect
Lethality assessment in children... Children have a lack of understanding of lethality, may be trying parasuicide and be too successful, distorted understanding of death, an immature way of looking at the world and their role in it and depression presents differently in children than adults
Neurological abnormalities found in children with autism enlarged ventricles and temporal lobe abnormalities
Manifestations of low plasma serotonin levels in children with ADHD Impulsivity and a lack of inhibition
Manifestations of low plasma norepinephrine levels in children with ADHD Decreased ability to analyze situations and reason through problems
Manifestations of low plasma dopamine levels in children with ADHD Difficulties in filtering sensory info, maintaining concentration, creating memories and controlling emotions
Behaviors in ADHD children associated w/ structural changes in prefrontal cortex Problems with judgement, attention span, organization, and behavior inhibition
ADHD behaviors associated w/ structural changes in basal ganglia of brain Impulsivity, hyperactivity, increased disinhibition
ADHD behaviors associated w/ structural changes in the hippocampus Concentration difficulties and memory development difficulties
ADHD behaviors associated w/ structural changes in the limbic system Difficulty with emotional regulation
ADHD fist line txt medication Methylphenidate (Ritalin)
Prescribed when children w/ ADHD don't respond to stimulants or develop tics Atomoxetine
Mechanism of action for Concentra, Strattera, Ritalin and Metadate in children with ADHD Block reuptake of norepinephrine and dopamine
Mech of action for Adderall in children with ADHD Stimulates release of norepinephrine
Oppositional Defiant Disorder characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance of frustration, and a tendency to blame others for problems
Conduct Disorder Characterized by serious violations of social norms incl aggression, destruction of property and cruelty to animals
Meds used to txt ODD and CD to treat extremely aggressive behavior Haloperidol, thiorodazine, carbamazepine, and risperidone
Created by: JaeLaw23